多器官功能障碍综合征回顾性分析及预后相关因素

目的]探讨多器官功能障碍综合征（MODS）的病因、临床生理特征、病死率以及死亡危险因素．方法]回顾性分析2010年1月2011年12月间收治的符合MODS诊断标准的69例患者临床资料，均在诊断MODS当天进行急性生理与慢性健康状况评分（APACHEII）及多器官功能障碍评分（MODS），其他指标包括年龄、性别、起病至确诊时间、既往慢性疾病史、RICU滞留时间、脏器损伤数目、血气分析指标（A—aDO2，RI）、乳酸（Lac）．结果]69例MODS患者主要致病因素为中毒（46．74％）及重症感染（18．48％）．生存组与死亡组起病至确诊时间、RICU滞留时间、APACHEII评分及MODS评分上差异均具有统计学意义（P〈0．05）．死亡组的A-aDO2，RI，Lac值明显高于生存组（P〈O．05）．MODS患者的病死率与发病至确诊时间、脏器损害数目呈正相关（P〈0．05）．MODS患者最易受累器官为肺（81．16％），其次为中枢神经系统（62．32％）及心脏（52．12％），累及心脏病死率最高（58．33％），死亡率高于中枢神经系统（48．84％）及肺（46．43％）．Logistic回9-5分析结果显示，脏器损害数目、Lac是影响MODS预后的独立危险因子．结论]中毒为MODS患者的主要致病因素．MODS患者最易受累器官为肺，其次为中枢神经系统，累及心脏病死率最高，其次为中枢神经系统及肺．脏器损害数目、APACHEII评分、MODS评分、Lac、A—aDO2及RI可作为影响MODS预后的危险因素，其中脏器损害数目、Lac可作为影响MODS预后的独立危险因子．

A retrospective analysis and study of prognostic relevant factors of multiple organ dysfunction syndrome

OBJECTIVE To explore the incidence, etiology, clinical and physiological characteristics, mortality and death risk factors of multiple organ dysfunction syndrome（MODS）. METHODS The clinical data of 69 cases of MODS were retrospectively analyzed from January 2010 to December 2011. The acute physiology, chronic health evaluation II and multiple organ dysfunction score were recorded when all the patients were diagnosed with MODS, and other variable records were age, sex, onset to diagnosis time, past chronic disease history, RICU residence time, organ injury number, indexes of blood gas analysis and lactate （Lac）, et al. RESULTS The main etiological factors of MODS were poisoning （46. 74%） and severe infection （18, 48%）. The onset to diagnosis time, past chronic disease history, RICU residence time, APACHE II score and MODS score were significantly different between survival and death groups （P 〈0.05）. The values of A-aDO2, RI and Lac were significantly higher in death group than in survival group （P〈0.05）. The mortality of MODS had positive correlation with the onset to diagnosis time and organ injury number （P〈0.05）. The most involved organs in MODS were the lungs （81.16%）, CNS （62.32%） and heart （52.12%）, and the mortality was the highest in heart （58.33%） than in CNS （48. 84%） and lungs （46.43%）. The Logistic regression analysis results showed that the organ injury number, onset to diagnosis time, APACHE II score, Lac, A-aDO2 and RI were independent risk factors for influencing the prognosis of MODS. CONCLUSION Poisoning is main pathogenic factor for MODS, and the most involved organs in MODS were the lungs and CNS, and the mortality of MODS is the highest in heart than in CNS and lungs. The organ injury number, APACHE II score, Lac, A-aDO2 and RI influencing the prognosis of MODS, and the organ injury number, and Lac can be used factor for influencing the prognosis of MODS.